Fan and Not-Fan Mail: "What Planet Was That Email From?" and "Fail to See the Humor"

First, the fan mail:

Earlier this week, I received a fun "shut up and burn in hell" letter. Mr. "Shut Up" argued that I was a horrible person for making fun of Bush, who "does as much as he can to rebuild a city that should be scrapped". Longtime reader Brenda Ann comes to my defense:

Mikhaela,

Read this bogus crap in your blog, Shut Up and Burn in Hell".

I'd just like to know what planet the e-mail came from.. in the world I live in, we had a record budget surplus going into the Bush presidency, and now have a record budget deficit... sounds more like he's doing what he can to START a depression (I know he certainly depresses ME)..

Don't think I've ever seen you advocate anything of the sort he's accusing you of, or let for sure never have seen you making fun of anyone trying to help someone.... or maybe his logic says that pulling kids out of loving homes and putting them into foster care or state homes is helping them?? Mind you, the system does need a lot of work.. but let's fix the shit that's broken, instead of breaking the stuff that isn't.

Take care, and stay well.

Brenda Ann
Still in S. Korea (and glad of it)

You might be onto something, Brenda Ann. Mr. "Shut Up" really must have his brain protruding into another dimension to think Bush gives a rats ass about New Orleans (or to argue that a city with such a rich culture, life and history "should be scrapped"?!).

Now, the not-such-a-fan mail: Marc Adels takes issue with my cartoon screed against Health Savings Accounts:

Dear Mikhaela Reid,

Saw your cartoon in metro times today didn't see the humor since unfortunately you have no idea how a health savings account works. Study after study has show that when a doctor knows a patient has health insurance and there is no incentive for the patient to say no to a procedure expense typically are 50% higher than if a patient had a vested interst in the plan.

One doctor has decided to stop accepting insurance from his clients if they would pay cash and he said he would price all his services between a tune-up and a brake job. Everyone is happy. Health insurance is designed for the serious events such as your cancer example which would be paid for totally by the insurance co. for all the treatment after the deductible of $1000 or $1500 is met which can be paid off ast $30 to $50 per month. You don't expect your auto insurance to pay for oil changes brake jobs or wheel alignments though you seem to be able to pay for these just fine. Why can't you pay for dr visits and Rx on your own if the are done at the discounted ppom rate and are 100%tax deductuble. This is the only way health insurance is going to be affordable. When a patient has no incentive to question if a test is needed costs are only going to sky rocket. After all you get a second opnion on major repairs to your home or car why should health care be any different? If you want to educate yourself let me know.

sincerely,
Marc Adels
Clawson, Mi

Marc, I agree that America's current haphazard health insurance system is seriously messed up. But the problem is that Americans have too little insurance and health care, not too much. 46 million Americans have no insurance. As Malcolm Gladwell wrote in an excellent New Yorker piece recently ("THE MORAL-HAZARD MYTH: The bad idea behind our failed health-care system"):

The U. S. health-care system... has created a group of people who increasingly look different from others and suffer in ways that others do not. The leading cause of personal bankruptcy in the United States is unpaid medical bills. Half of the uninsured owe money to hospitals, and a third are being pursued by collection agencies. Children without health insurance are less likely to receive medical attention for serious injuries, for recurrent ear infections, or for asthma. Lung-cancer patients without insurance are less likely to receive surgery, chemotherapy, or radiation treatment. Heart-attack victims without health insurance are less likely to receive angioplasty. People with pneumonia who don’t have health insurance are less likely to receive X rays or consultations. The death rate in any given year for someone without health insurance is twenty-five per cent higher than for someone with insurance. Because the uninsured are sicker than the rest of us, they can’t get better jobs, and because they can’t get better jobs they can’t afford health insurance, and because they can’t afford health insurance they get even sicker.

Again, our problem is too little health insurance, and health savings accounts, which come coupled with high-deductible health plans, are not the solution. They make sense only for the wealthy and the healthy—and this being a crazy world full of chance and accidents and sudden illness, anyone could lose the latter at any time. A plan with a deductible of at least $1,050 per individual is an unworkable "splurge" for a person who can barely pay her rent. Out-of-pocket costs can be as high as $5,250 for an individual, $10,500 for a family. So when the choice is between buying dinner and "optional" preventive care visits, what is a low-income family going to choose? Again, from Gladwell:

People without health insurance have bad teeth because, if you’re paying for everything out of your own pocket, going to the dentist for a checkup seems like a luxury. It isn’t, of course.

Missing an oil change isn't a catastrophe. Missing a mammogram is. And comparison shopping and tax breaks are only rewarding if you have money to shop with and plenty of taxable income to get a break on.

But HSAs aren't just a problem on an individual level. They also go against the whole idea of insurance, which is to pool risk, slightly raising costs for the currently healthy and lowering costs for those of us who are sicker and/or older--which all young and/or healthy people will be some day.

Sure our current health care system sucks. But this country is too pig-headed to do the right thing and go for single-payer insurance. Long live the freedom for poor people to get cheap crappy health care or none at all!

See also my earlier blog post on this subject, which has lots more links and info.